Leaders of adult day health care centers at financial risk say it's too early to know whether a Medi-Cal transition that started last week will serve as a safety net.

"I still don't know what's going to happen to us," said Kiana Bahadoran, co-owner of Advanced Adult Day Health Care Center in Simi Valley. "Worry is my other name these days. I wake up with worries, and I sleep with worries."

On Oct. 1, a long Medi-Cal transition reached culmination. Instead of being paid by a state-run agency to provide Medi-Cal care to 784 seniors and disabled people in and around Ventura County, the centers now will be paid by a managed care agency that administers the Medi-Cal insurance program locally, the Gold Coast Health Plan.

The change is rooted in a lawsuit filed after state leaders tried to eliminate California's adult day health care program to reduce costs. Client advocates said the cut would end up putting seniors who receive therapy, nursing care and other services at the centers into hospitals and nursing homes.

A settlement created a compromise program, Community Based Adult Services. Although the five Ventura County centers in the program provide the same services they did in adult day health care, Community Based Adult Services is designed to save the state money by serving fewer people and coordinating care better.

Locally, about 60 people in the old program were deemed ineligible for the new program. Nearly all of them are appealing the ruling, and even if it stands, they may still be eligible for therapy and other care based on individual needs.

On Oct. 1, Gold Coast took over managing the care and paying the bill for county residents receiving services at the health care centers. A similar transition has taken place in 29 other counties.

Leaders of some local centers say the transition is off to a smooth start.

"So far, so good," said Mark Kovalik, administrator of Among Friends Adult Day Health Care in Oxnard. "Both organizations, Gold Coast and us, have to go through a learning curve, but they've been very cooperative."

Kovalik said Among Friends is in no danger of closing. Leaders of the Oxnard Family Circle Adult Day Health Care Center say the same thing.

Leaders of other centers say they were hit hard by payment delays in the state-administered program. They worry some clients may lose their appeals to stay in the program. They cite a 10 percent reimbursement cut that began in December and affected centers not shielded by an exemption.

"That's the biggest problem," said Andre Nikiforov, administrator of Millennium Adult Day Health Care in Simi Valley. He said the center is in the red every month and in danger of closing.

"Oh, yeah," he said. "It's every day. Same worry."

The Ventura County Adult Day Health Care Center in Oxnard isn't in immediate jeopardy but has been hurt by payment delays.

"We are struggling to stay open," said Joni Young, acting program director. "We are hoping that with this transition we'll get more of our (payment requests) approved. I'm hopeful it will work out."

Gold Coast officials say they want to make payments to the centers every other week and use electronic fund transfers to save time.

"We understand they are a thin-margin business and cash flow is critically important to them," said Gold Coast CEO Michael Engelhard, adding that the purpose of the centers is to help people stay out of nursing homes. "We absolutely want them to stay open."

Gold Coast has struggled with payment issues before, but officials say the problems have largely been resolved. Engelhard said Gold Coast staff members are contacting health care providers daily and working to make the transition as smooth as possible. He said anxiety is expected, particularly from centers in a financial crunch.

"Our goal is to lower that anxiety by being a good business partner," he said.